Influenza pandemics are among the foremost international public health challenges of the 21st century. Eleven probable and three possible pandemics have occurred in the past four-hundred years. The April, 2009 outbreak of a novel strain of influenza A (H1N1) in Mexico City demonstrated that infection can be transmitted globally in days and cause disproportionate morbidity and mortality in young adults, pregnant women, and minorities. The 2009 (H1N1) Pandemic has been defined by its transmissibility and case- fatality proportion as a mild pandemic; the WHO estimates that a more severe pandemic could cause hundreds of millions of deaths, and overwhelm healthcare capacity. Even during this mild pandemic, hospitals and ICUs were operating near or at surge capacity during peaks of transmission. Public health officials have limited decision support technology to plan for or prevent healthcare utilization surge in future influenza pandemics. Despite an appropriate public health response to the ongoing pandemic, several influenza A viruses remain pandemic threats. The exact timing of the next influenza pandemic is uncertain, but there is no doubt that another one will occur. Over the past three years, I have developed skills in cost-effectiveness analysis and infectious disease modeling by designing an influenza disease transmission model to compare the effectiveness and cost- effectiveness of alternative pandemic mitigation strategies. Several of my model parameters are based on assumptions or data from seasonal influenza epidemics or 20th century pandemics, and my model is limited to the spread of pandemic influenza within a city. I would like to improve the accuracy of the model parameters and expand its geographical scope in order to compare the effectiveness of healthcare utilization surge preparation strategies and to inform pandemic healthcare decision support. To do so, I need to develop additional skills in large database analysis and multivariable statistical modeling by completing coursework and projects under the guidance of an experienced, multi-disciplinary team of mentors and advisors. Combined with my existing methodological background, these skills will enable me to perform research as an independent investigator in infectious disease health policy. The 2009 (H1N1) Pandemic, occurring in an era with advanced healthcare database collection, has provided a unique opportunity for me to meet all of these objectives by: (1) Measuring influenza-related healthcare costs and utilization during a pandemic; (2) Incorporating length-of-stay results from Aim 1 into multivariate analyses to predict the temporal spread of peak influenza healthcare utilization; (3) Inputting results of Aims 1 and 2 into my pandemic influenza transmission model to compare the effectiveness and cost-effectiveness of alternative surge preparation strategies over a range of pandemic severities; and (4) Disseminating results of Aims 1, 2, and 3 through CDC to update healthcare decision support technology. PUBLIC HEALTH RELEVANCE: Influenza pandemics have occurred throughout recorded history; future pandemics, potentially far more severe than the 2009 (H1N1) Pandemic, continue to be serious threats. Public health officials have limited decision support technology to plan for or prevent healthcare utilization surge in future influenza pandemics. These projects will examine the comparative effectiveness of alternative pandemic preparedness and mitigation strategies, and update decision support technologies to assist public health officials for surge preparedness and response.